Cheng Pingping, Ying Feng, Li Yafeng
Department of Anesthesiology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330000, China.
Evid Based Complement Alternat Med. 2022 Aug 25;2022:4096005. doi: 10.1155/2022/4096005. eCollection 2022.
To investigate the effects of lumbar plexus-sciatic nerve block with different concentrations of ropivacaine on recovery from anesthesia, postoperative pain, and cognitive function in elderly patients with femoral neck fracture.
A total of 110 elderly patients with femoral neck fractures who were treated in our hospital from January 2020 to January 2022 were selected as the research objects. According to the concentration of ropivacaine, they were divided into low-, medium-, and high-concentration groups (concentrations of ropivacaine were 0.15%, 0.25%, and 0.40%, respectively), with 36, 37, and 37 cases, respectively. Extubation time, anesthesia recovery time, and hospitalization time were recorded. Cognitive symptoms were assessed by the spatial cognitive ability, working memory ability, simple computing ability, and picture recognition ability test. The pain degree of patients was assessed by visual analogue scale (VAS). The occurrence of adverse reactions in patients was recorded.
There was no significant difference in extubation time, anesthesia recovery time, and hospitalization time among the three groups ( > 0.05). The PCA time of the patients in the high-concentration group was significantly longer than that in the low- and medium-concentration groups. The dosage of sufentanil within 24 hours and total sufentanil in the high-concentration group were significantly lower than those in the low- and medium-concentration groups, and the dosage of sufentanil within 24 hours and total sufentanil in the medium-concentration group was significantly less than that in the low-concentration group ( < 0.05). The cognitive function score for each entry of the three groups 1 d after surgery was lower than that before surgery ( < 0.05); On the 1 day after operation, the cognitive function score for each entry of the patients in the low-concentration group was significantly higher than that in the middle- and high-concentration groups, and the cognitive function score for each entry in the middle-concentration group was significantly higher than that in the high-concentration group ( < 0.05). There was no significant difference in VAS scores between the three groups at 2 h and 8 h after surgery ( > 0.05); 16 h and 24 h after operation, the VAS score of patients in the high-concentration group was significantly lower than that in the low- and medium-concentration groups, and the VAS score in the medium-concentration group was significantly lower than that in the low-concentration ropivacaine group ( < 0.05). The incidence of adverse reactions in the high-concentration ropivacaine group was significantly higher than that in the low- and medium-concentration groups ( < 0.05).
The middle concentration of ropivacaine has good analgesic and nerve block effects and has less influence on cognitive function and less adverse reactions in elderly patients.
探讨不同浓度罗哌卡因腰丛-坐骨神经阻滞对老年股骨颈骨折患者麻醉恢复、术后疼痛及认知功能的影响。
选取2020年1月至2022年1月在我院治疗的110例老年股骨颈骨折患者作为研究对象。根据罗哌卡因浓度分为低、中、高浓度组（罗哌卡因浓度分别为0.15%、0.25%和0.40%），每组分别为36例、37例和37例。记录拔管时间、麻醉恢复时间和住院时间。通过空间认知能力、工作记忆能力、简单计算能力和图片识别能力测试评估认知症状。采用视觉模拟评分法（VAS）评估患者疼痛程度。记录患者不良反应发生情况。
三组患者的拔管时间、麻醉恢复时间和住院时间比较，差异无统计学意义（P>0.05）。高浓度组患者的术后自控镇痛（PCA）时间显著长于低、中浓度组。高浓度组患者24小时内舒芬太尼用量及舒芬太尼总量显著低于低、中浓度组，中浓度组患者24小时内舒芬太尼用量及舒芬太尼总量显著少于低浓度组（P<0.05）。三组患者术后1天各条目认知功能评分均低于术前（P<0.05）；术后1天，低浓度组患者各条目认知功能评分显著高于中、高浓度组，中浓度组各条目认知功能评分显著高于高浓度组（P<0.05）。三组患者术后2小时和8小时的VAS评分比较，差异无统计学意义（P>0.05）；术后16小时和24小时，高浓度组患者的VAS评分显著低于低、中浓度组，中浓度组的VAS评分显著低于低浓度罗哌卡因组（P<0.05）。高浓度罗哌卡因组不良反应发生率显著高于低、中浓度组（P<0.05）。
中等浓度罗哌卡因对老年患者具有良好的镇痛和神经阻滞效果，对认知功能影响较小，不良反应较少。
